Workers Compensation Claims Examiner I NY license required I Remote

Lensa; Tampa (FL); Remote; USD 56,000 - 80,000; Full time

Job summary

A leading company in risk and claims management is seeking a Workers Compensation Claims Examiner. The role involves analyzing complex claims, negotiating settlements, and ensuring timely payments. Join a culture that values work-life balance and professional growth while making a meaningful impact.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401k

PTO

Disability Insurance

Life Insurance

Qualifications

• Minimum five years of claims management or equivalent experience.

Responsibilities

• Analyze and process complex workers' compensation claims.
• Negotiate claim settlements within authority limits.
• Manage litigation processes and ensure cost-effective resolutions.

Skills

Insurance principles

Communication

Negotiation

Organizational

Teamwork

Service orientation

Education

Bachelor's degree

Job description

Workers Compensation Claims Examiner I NY license required I Remote

2 days ago - Be among the first 25 applicants

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Sedgwick, is seeking professionals. Apply via Lensa today!

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. There’s no limit to what you can achieve.

Recognitions include Newsweek's America’s Greatest Workplaces, Certified as a Great Place to Work, Fortune's Best Workplaces in Financial Services & Insurance.

PRIMARY PURPOSE

Analyze complex workers' compensation claims to determine benefits due, work with high exposure claims involving litigation and rehabilitation, ensure claims are adjudicated within service expectations, and identify subrogation opportunities and negotiate settlements.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Analyze and process complex workers' compensation claims, investigate and gather information to assess exposure, and manage claims to resolution.
• Negotiate claim settlements within authority limits.
• Assign and manage reserves appropriately throughout the claim lifecycle.
• Calculate and disburse benefits, ensure timely payments, and settle claims within authority.
• Prepare necessary filings within statutory limits.
• Manage litigation processes, ensuring cost-effective resolutions.
• Coordinate referrals for investigation and litigation management.
• Apply cost containment techniques, including vendor partnerships.
• Manage claim recoveries, including subrogation and offsets.
• Report claims to excess carriers and respond to inquiries professionally.
• Communicate with claimants and clients, maintaining professional relationships.
• Ensure proper documentation and coding of claim files.
• Refer cases to supervisors as needed.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

• Perform other duties as assigned.
• Support quality programs.
• Travel as required.

QUALIFICATIONS

Education & Licensing: Bachelor's degree preferred; professional certifications as applicable.

Experience: Minimum five years of claims management or equivalent.

Skills & Knowledge: Insurance principles, laws, recoveries, cost containment, medical management, social security, Medicare, communication, organizational, negotiation, teamwork, service orientation.

WORK ENVIRONMENT

Accommodations considered. Mental, physical, and auditory/visual requirements outlined. Work includes computer use and travel.

Salary range for the jurisdiction: $56,909 - $79,672. Benefits include medical, dental, vision, 401k, PTO, disability, life insurance, and more.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. We encourage applicants with diverse backgrounds to apply, even if not all qualifications are met.

Sedgwick is a global leader in risk and claims management, leveraging advanced AI technology. With over 33,000 colleagues and 10,000 clients worldwide, we provide innovative solutions for complex risk landscapes.